{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:10:36Z","timestamp":1754093436825,"version":"3.41.2"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008460","name":"National Center for Complementary and Integrative Health","doi-asserted-by":"publisher","award":["T90 AT008544"],"award-info":[{"award-number":["T90 AT008544"]}],"id":[{"id":"10.13039\/100008460","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of School Health"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>School based health centers (SBHCs) are essential for providing health care to students. Literature demonstrates student characteristics such as race and income are associated with SBHC utilization; however, little data exists on temporal trends in utilization. This gap in knowledge is crucial for informing policies and resource allocation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study examined utilization across 27 SBHCs at elementary, middle, and high schools in King County, Seattle from 2017 to 2021. Negative binomial models with random intercepts were constructed to evaluate semester\u2010level variation in utilization, accounting for school\u2010level differences in race, income, and attendance. Interaction models were constructed to test for effect modification of utilization by race, income, and attendance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Findings indicate that higher rates of utilization occurred in the fall. There was a decrease in utilization during the study, potentially due to the pandemic. Lower school\u2010level income was positively and significantly associated with higher utilization and none of the interaction models were significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications<\/jats:title><jats:p>Our study holds important implications for planning and policy recommendations surrounding SBHC care delivery, such as the potential need for more staffing to meet the higher demand in the fall.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SBHC utilization varies by semester and schools serving low\u2010income communities may experience higher rates of utilization, requiring increased staffing needs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/josh.70045","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T01:18:56Z","timestamp":1751591936000},"page":"723-730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences Exist in Utilization of School Based Health Centers by School Semester and by Proportion of Low\u2010Income Students*"],"prefix":"10.1111","volume":"95","author":[{"given":"Jenna","family":"Van Draanen","sequence":"first","affiliation":[{"name":"Department of Health Systems and Population Health University of Washington  Seattle Washington USA"},{"name":"Department of Child, Family, and Population Health Nursing University of Washington School of Nursing  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7484-4749","authenticated-orcid":false,"given":"Taylor C.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health University of Washington  Seattle Washington USA"},{"name":"Department of Child, Family, and Population Health Nursing University of Washington School of Nursing  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3211-9279","authenticated-orcid":false,"given":"Luciano","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Department of Child, Family, and Population Health Nursing University of Washington School of Nursing  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6079-4629","authenticated-orcid":false,"given":"Brenda Y.","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health University of Washington  Seattle Washington USA"},{"name":"Department of Child, Family, and Population Health Nursing University of Washington School of Nursing  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Rigel","sequence":"additional","affiliation":[{"name":"Public Health Seattle &amp; King County  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha T.","family":"Yeun","sequence":"additional","affiliation":[{"name":"Public Health Seattle &amp; King County  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"MacDougall","sequence":"additional","affiliation":[{"name":"Public Health Seattle &amp; King County  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1950-5837","authenticated-orcid":false,"given":"Michael","family":"Nash","sequence":"additional","affiliation":[{"name":"University of Washington, Center for Biomedical Statistics  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.01.009"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2020.04.026"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/003335490812300610"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2333794X19828745"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cppeds.2012.03.002"},{"key":"e_1_2_8_7_1","unstructured":"Washington State Health Care Authority DoH Office of the Superintendent of Public Instruction and Liquor and Cannabis Board \u201cData from: Health Youth Survey Data Analysis & Technical Assistance Manual \u201d2019."},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.97.3.318"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.153.3.235"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/1054-139X(95)00236-L"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10566-019-09495-8"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.34532"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/josh.13226"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.24984"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","unstructured":"R.Moynihan S.Sanders Z. 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